Care integration must tackle inequality

A draft prospectus for the two- year initiative, first announced in the next stage review, requires pilot schemes to include a general commitment to reducing health inequalities and a "specific commitment" to tackling at least one type of in-equality, for instance, race, gender, disability, religion or sexuality. The schemes will also have to deliver a "step change" in clinical and care results and patient reported outcomes and they will be subject to a three-year evaluation.

In a sign that the department is keen to push ahead, the timescale has been brought forward three months and schemes must be implemented before the end of the year. But questions have been raised over whether the long term goals of the pilot have been defined clearly.

Oliver Bernath, managing director of Integrated Health Partners, an integration specialist, welcomed the scheme's focus on connecting prevention and promotion, and community, primary, specialist and secondary care, and the degree of support the initiative was receiving. But he warned that the prospectus was unclear about how much freedom integrated care organisations could expect in the future. He said: "The long term vision is not as clearly outlined as I thought it would be."

Budget expectations

Dr Bernath said he had understood there would be a long term expectation on providers to take on comprehensive capitated budgets. "That should be clearer so people know what the game is and what the pilot should prove," he said.

NHS Alliance chair Michael Dixon said the focus on tackling health inequalities should ensure schemes focused on a "wide spectrum of activity" or they would not be able to make a difference. He said: "I would be very disappointed if this ended up as no more than integrating one or two services. Nobody wants a short term blast of change that doesn't create sustainable lessons."

Dr Dixon said he expected to see a mix of primary and community care pilots and schemes drawing together primary and secondary care. But he warned that payment by results could act as a block to vertically integrated schemes.

Strategic health authorities will be able to join a steering group that ensures effective risk management and learning. Primary care trusts must demonstrate world class commissioning competencies to be eligible and pilot sites will have to demonstrate a "track record in innovation or transformation".